Provider Demographics
NPI:1558319921
Name:GROSSE POINTE UROLOGIC SURGEONS
Entity Type:Organization
Organization Name:GROSSE POINTE UROLOGIC SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TELANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-773-6300
Mailing Address - Street 1:18325 10 MILE
Mailing Address - Street 2:STE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066
Mailing Address - Country:US
Mailing Address - Phone:586-773-6300
Mailing Address - Fax:586-773-6266
Practice Address - Street 1:18325 10 MILE
Practice Address - Street 2:STE 200
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066
Practice Address - Country:US
Practice Address - Phone:586-773-6300
Practice Address - Fax:586-773-6266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC10675OtherRAILROAD MEDICARE PIN
MI0E01005OtherBCBS
MIC10675OtherRAILROAD MEDICARE PIN
MI1005840001Medicare NSC